右旋美托咪啶辅助颈丛神经阻滞在甲状腺手术的临床观察

目的评价右旋美托咪啶辅助颈丛阻滞在甲状腺手术的效果。方法将60例ASAⅠ～Ⅱ级择期行甲状腺手术病人随机分为右旋美托咪啶组(D组)和对照组(C组),每组30例。分别予D组输注负荷剂量右旋美托咪啶0.4μ/kg(5min内)后,以0.4μg.kg-1.h-1维持,手术结束前5min停药;C组静脉注入氟芬合剂2ml。记录两组患者颈丛阻滞前(T0)、颈丛阻滞后10min(TI)、手术开始后5min(T2)、30min(T3)、分离腺体(T4)和切除腺体(T5)等各时间段的平均动脉压(MAP)、HR、脉搏血氧饱和度(SpO2),视觉模拟评分(VSA)评价术中疼痛程度,Ramsay评分评价镇静程度,同时记录呼吸抑制、恶心呕吐等不良反应的发生情况。结果与C组相比,D组T0、T1、T2、T3、T4、T5时MAP、HR下降,差异均有统计学意义(t分别=5.08、5.03、4.60、6.54、5.56;8.78、7.95、9.61、7.84、8.15,P均<0.05);VAS评分、Ramsay评分明显优于C组,差异均有统计学意义(t分别=8.20、2.23、8.75、10.12;14.63、6.24、10.20、9.46,P均<0.05);不良反应明显减少。结论右旋美托咪啶辅助颈丛阻滞行甲状腺切手术,可使患者达到充分的镇静、镇痛作用,且不增加不良反应,还可预防颈丛神经阻滞后心血管副作用。

Clinical observation on dexmedetomidine as adjuvant for cervical plexus block in thyroid surgery

Objective To observe the effects of cervical plexus block assisted with dexmedetomidine on thyroidectomy.Methods Sixty patients（ASA Ⅰ orⅡ） undergoing thyroid gland surgery were randomly divided into 2 groups,group D and group C,30 patients in each group.In group D,the patients were first administrated with cervical plexus block,and then were intravenously treated with dexmedetomidine,first with loading dose of 0.4 μg within 5 minutes,and then with maintaining dose of 0.4 μg·kg-1·h-1.the dexmedetondine was stopped 5 minutes before the end of surgery.The Group C were given 2 ml innovar intravenously after the cervical plexus block.MAP,HR,Ramsay Sedation Score and VAS were recorded before the cervical plexus block（T0,baseline）,l0 min after the block（T1）,5 min（T2）,30 min（T3） after the skin incision,during the separation of glands（T4） and at the time of removing the gland（T5）.Results Compared with group C,group D T1～T5 MAP,HR decreased,the differences were statistically significant（t =5.08,5.03,4.60,6.54,5.56,8.78,7.95,9.61,7.84,8.15,P0.05）;VAS score,Ramsay score was significantly higher than that of C group,the differences were statistically significant（t=8.20,2.23,8.75,10.12,14.63,6.24,10.20,9.46,P0.05）;The adverse reactions were also fewer.Conclusions As an adjuvant for the cervical plexus block in thyroidectomy,the dexmedetondine has reliable effects of analgesic and sedation,and there is no increase in the adverse reaction.It also can prevent the cardiovascular adverse reactions of cervical plexus block.